From the Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, the Netherlands.
Stroke. 2018 Jul;49(7):1762-1765. doi: 10.1161/STROKEAHA.118.021514. Epub 2018 May 29.
There is no consensus on whether anticoagulation should be continued or temporarily stopped in patients suffering acute ischemic stroke while using anticoagulation. We assessed treatment variations and outcomes in these patients.
Post hoc analysis of PASS (Preventive Antibiotics in Stroke Study). We included patients with acute ischemic stroke who used anticoagulation at admission. We compared clinical outcomes, thrombotic, and major bleeding events at 3 months.
Nine percent (192/2101) of the patients with acute ischemic stroke used anticoagulation at admission (186 vitamin K antagonists). Anticoagulation was discontinued in 35/192 (18%) patients. These patients had higher National Institutes of Health Stroke Scale scores than patients in whom anticoagulation was continued (median, 13 versus 4; <0.001). Thrombotic events occurred more frequently in patients in whom anticoagulation was discontinued (11% versus 3%; =0.038). There were no major bleeding events in either group. Mortality and clinical outcomes at 90 days were worse in patients in whom anticoagulation was discontinued (mortality, 31% versus 15%; =0.019 and modified Rankin Scale score of 0-2, 20% versus 55%; <0.001). After adjustment for potential confounders, there were no statistically significant differences between groups.
In our study, clinicians tended to continue anticoagulation in patients with acute ischemic stroke. Discontinuation was associated with an increased risk of thrombotic events and worse clinical outcome. Risk of major bleeding was not increased in patients in whom anticoagulation was continued.
URL: https://www.controlled-trials.com. Unique identifier: ISRCTN66140176.
对于正在使用抗凝药物的急性缺血性脑卒中患者，抗凝治疗应继续还是暂时停止，目前尚无共识。我们评估了这些患者的治疗差异和结局。
对 PASS（预防抗生素在卒中研究）进行事后分析。我们纳入了入院时使用抗凝药物的急性缺血性脑卒中患者。我们比较了 3 个月时的临床结局、血栓事件和主要出血事件。
9%（192/2101）的急性缺血性脑卒中患者入院时使用抗凝药物（186 例维生素 K 拮抗剂）。35/192（18%）的患者停止了抗凝治疗。与继续抗凝的患者相比，停止抗凝的患者 NIHSS 评分更高（中位数，13 分比 4 分；<0.001）。停止抗凝的患者血栓事件更常见（11%比 3%；=0.038）。两组均无主要出血事件。停止抗凝的患者 90 天时的死亡率和临床结局更差（死亡率 31%比 15%；=0.019 和改良 Rankin 量表评分为 0-2 的患者比例 20%比 55%；<0.001）。调整潜在混杂因素后，两组间无统计学差异。
在我们的研究中，临床医生倾向于继续对急性缺血性脑卒中患者进行抗凝治疗。停止抗凝与血栓事件风险增加和临床结局恶化相关。继续抗凝的患者未增加大出血风险。
